Further to my piece on Manchester’s “Health Devolution”, I thought it worth returning to something I wrote over 4 years ago, in rather different times. The question that I didn’t try to answer in last week’s piece was “what’s the alternative”. In the piece linked below, I tried to approach this, starting from first principles. The piece doesn’t directly deal with the devolution question, although it implicitly affirms the subsidiary principle – work at the appropriate level, depending on the issue. What it does try to do is ask what would be the alternative to “top-down” Statist command on control, and the anarchy of the market. After reviewing the alternatives I opt for a participative, deliberative model, one that would require an investment in democratic education and empowerment., and an onslaught on the commercial interests that the neoliberal governments of the last thirty years have allowed in to a health service that from 1948 was based on the premise that human need and social solidarity trumps private gain. Were I to write it today, it would look somewhat different, but I stand by a lot of it.